2007 IDSA ATS Guidelines Quiz
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Questions and Answers

What did the 2007 IDSA ATS Guidelines conclude regarding the timing of antibiotic administration for pneumonia?

  • Administration should never exceed four hours after diagnosis.
  • It strongly recommends administration within the first two hours.
  • Only early therapy is associated with reduced mortalities.
  • A specific time interval for administration is not recommended. (correct)

    • Which of the following was associated with unnecessary complications according to the guidelines?

  • Focusing excessively on early antibiotic therapy. (correct)
  • Administering antibiotics too late.
  • Not using antibiotics at all.
  • Delivering antibiotics without a diagnosis.

    • Which of the following studies supports the idea that early antibiotic administration can be seen as a marker of quality care?

  • Simonetti A et al. (2012)
  • Philippine Clinical Practice Guidelines (2004)
  • Bordon J et al. (2013) (correct)
  • Gattarello S et al. (2015)

    • Which pathogen is NOT associated with low-risk community-acquired pneumonia (CAP)?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What was one potential downside of early therapy identified in the guidelines?

    <p>Overuse of antibiotics causing complications.</p> Signup and view all the answers

    What is the recommended oral dosage for levofloxacin when switching from parenteral therapy?

    <p>500 mg OD</p> Signup and view all the answers

    Why might focusing on early administration of antibiotics be misleading according to the guidelines?

    <p>It does not accurately predict patient outcomes.</p> Signup and view all the answers

    What inconsistency was found in the outcomes of patients receiving antibiotics at different times?

    <p>There was no significant difference between the two groups.</p> Signup and view all the answers

    Which of the following antibiotics should be used to de-escalate therapy for a comorbid patient with CAP?

    <p>Amoxicillin-clavulanic acid 625 mg TID</p> Signup and view all the answers

    Which of the following findings was associated with administering antibiotics within 4 hours of hospital arrival?

    <p>Reduced mortality rates in some studies.</p> Signup and view all the answers

    Which therapy combination is appropriate for a low-risk CAP patient without co-morbid illness?

    <p>β-lactam and azithromycin</p> Signup and view all the answers

    What is the primary focus of the 2007 IDSA ATS Guidelines regarding antibiotic administration timing?

    <p>To recommend individualized treatment approaches.</p> Signup and view all the answers

    What is the primary goal of switching from parenteral to oral antibiotics in CAP therapy?

    <p>Lower cost and increased patient compliance</p> Signup and view all the answers

    What is the primary consideration when determining which oral antibiotics to use during switching therapy?

    <p>Culture results and antimicrobial spectrum</p> Signup and view all the answers

    In the management of CAP, when is the patient's hydration status particularly important?

    <p>When switching to oral medications</p> Signup and view all the answers

    What is the correct dosage for cefuroxime axetil when used for CAP?

    <p>500 mg BID</p> Signup and view all the answers

    What is a reason for a lack of response to treatment of community-acquired pneumonia (CAP)?

    <p>Antibiotics not administered</p> Signup and view all the answers

    Which of the following is NOT a potential cause for inadequate treatment response in CAP?

    <p>Empirical therapy directed towards the right organism</p> Signup and view all the answers

    For a hospitalized patient with CAP, when can discharge occur?

    <p>When the patient is clinically stable and oral therapy is initiated</p> Signup and view all the answers

    Which of the following characteristics is NOT a criterion for discharge of a CAP patient?

    <p>Temperature of 38.5oC</p> Signup and view all the answers

    Which factor may hinder the effectiveness of the antibiotic therapy in CAP?

    <p>Drug-induced fever</p> Signup and view all the answers

    What is a common reason for treatment failure in CAP related to the patient's specific condition?

    <p>Obstruction due to lung cancer or foreign body</p> Signup and view all the answers

    What should be performed approximately 4 to 6 weeks after hospital discharge for CAP?

    <p>A follow-up chest radiograph</p> Signup and view all the answers

    Which scenario might suggest a loculated infection in a CAP patient?

    <p>Presence of empyema requiring drainage</p> Signup and view all the answers

    What is the standard drug of choice for low-risk community-acquired pneumonia without comorbid illness?

    <p>Amoxicillin</p> Signup and view all the answers

    Which combination of antibiotics is recommended for low-risk community-acquired pneumonia with stable comorbid illness?

    <p>β-lactam with β-lactamase inhibitor combinations</p> Signup and view all the answers

    What should be done for patients who do not respond to initial treatment for low-risk community-acquired pneumonia?

    <p>Conduct an extensive work-up to identify factors for failure of response</p> Signup and view all the answers

    For moderate-risk community-acquired pneumonia, what type of antibiotic treatment combination is recommended?

    <p>An IV non-antipseudomonal β-lactam with an extended macrolide or respiratory fluoroquinolone</p> Signup and view all the answers

    What is recommended for high-risk community-acquired pneumonia without risk for Pseudomonas aeruginosa?

    <p>An IV non-antipseudomonal β-lactam with an IV extended macrolide or IV respiratory fluoroquinolone</p> Signup and view all the answers

    What treatment combination is recommended for high-risk community-acquired pneumonia with a risk for Pseudomonas aeruginosa?

    <p>An IV antipneumococcal, antipseudomonal β-lactam with an extended macrolide and aminoglycoside or an IV ciprofloxacin</p> Signup and view all the answers

    In treating community-acquired pneumonia, what role does a respiratory fluoroquinolone play in moderate-risk patients?

    <p>It can be used along with non-antipseudomonal β-lactam</p> Signup and view all the answers

    Which antibiotic is considered when using extended macrolides for low-risk community-acquired pneumonia?

    <p>Azithromycin</p> Signup and view all the answers

    What is the maximum duration for antibiotic therapy in bacteremic MRSA pneumonia?

    <p>28 days</p> Signup and view all the answers

    For community-acquired pneumonia caused by Pseudomonas aeruginosa, what is the duration for non-bacteremic cases?

    <p>14-21 days</p> Signup and view all the answers

    What is the appropriate duration of antibiotic therapy for Mycoplasma and Chlamydophila pneumonia?

    <p>10-14 days</p> Signup and view all the answers

    How long should antibiotic therapy last for non-bacteremic MRSA pneumonia cases?

    <p>14-21 days</p> Signup and view all the answers

    What is the duration of antibiotic therapy for Legionella pneumonia?

    <p>14-21 days</p> Signup and view all the answers

    For bacteremic cases of pneumonia caused by Pseudomonas aeruginosa, what is the maximum recommended duration of therapy?

    <p>28 days</p> Signup and view all the answers

    What is the antibiotic therapy duration for non-bacteremic pneumonia caused by Mycoplasma?

    <p>10-14 days</p> Signup and view all the answers

    Which of the following durations is not recommended for antibiotic therapy in non-bacteremic pneumonia due to Chlamydophila?

    <p>28 days</p> Signup and view all the answers

    Study Notes

    2007 IDSA ATS Guidelines on Antibiotic Administration

    • Inconsistencies noted between patients receiving antibiotics within two hours vs. two to four hours post-diagnosis.
    • Early administration linked to reduced mortality; however, overemphasis could lead to unnecessary antibiotic use and complications.
    • No specific time interval for antibiotic administration is recommended in the current guidelines.
    • Low-risk CAP without comorbid illness: Amoxicillin as the drug of choice; consider extended macrolides.
    • Low-risk CAP with stable comorbid illness: β-lactam with β-lactamase inhibitors or second-generation cephalosporins; optional extended macrolides.
    • Moderate-risk CAP: Combination of IV non-antipseudomonal β-lactam with either an extended macrolide or a respiratory fluoroquinolone recommended.
    • High-risk CAP without Pseudomonas risk: Combination of IV non-antipseudomonas β-lactam with extended macrolide or respiratory fluoroquinolone.
    • High-risk CAP with Pseudomonas risk: IV antipneumococcal, antipseudomonal β-lactams with extended macrolide and aminoglycoside or ciprofloxacin/high-dose levofloxacin.

    Empiric Antimicrobial Therapy Dosage Table

    • Low-risk CAP: Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae targeted with Azithromycin + β-lactam agents.
    • Dosages for commonly used antibiotics include:
      • Amoxicillin-clavulanic acid: 625 mg TID or 1 gm BID
      • Azithromycin: 500 mg OD
      • Levofloxacin: 500 - 750 mg OD

    Criteria for Discharge of Hospitalized CAP Patients

    • Patients can be discharged once clinically stable and oral therapy is initiated, barring life-threatening complications.
    • No repeat chest radiograph required prior to discharge, but recommended follow-up roughly 4-6 weeks post-discharge for new radiographic baseline.

    Characteristics for Discharge Within 24 Hours

    • Temperature between 36-37.5°C
    • Pulse rate < 100 bpm
    • Respiratory rate between 16-24/minute
    • Systolic BP > 90 mmHg
    • Blood oxygen saturation > 90%
    • Functioning gastrointestinal tract

    Considerations for Treatment Failure

    • Potential reasons for lack of response to treatment include:
      • Inappropriate antibiotic choice or dose.
      • Resistance of organism to selected antibiotic.
      • Non-identification of the causative organism.
      • Incorrect identification of pathogens.

    References for Further Reading

    • Studies discussing duration and efficacy of antibiotic therapy in hospitalized CAP patients indicate varying practices and recommendations.
    • Importance of follow-up and re-evaluation in ongoing management, particularly in patients with complex medical histories.

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    Related Documents

    Philippine Clinical Practice Guidelines for Community-Acquired Pneumonia (CAP) 2016 Update PDF

    Description

    Test your understanding of the 2007 IDSA ATS guidelines concerning antibiotic treatment timing and its impact on patient outcomes. This quiz will cover key findings and recommendations to optimize antibiotic use in clinical settings. Explore the balance between early therapy and potential complications due to unnecessary antibiotic prescriptions.

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